Antimicrobials May Lower Risk of Urinary Tract Infection After Catheterization

For hospitalized patients with short-term urinary catheterization, giving antibiotics after catheter removal can reduce the risk of urinary tract infection (UTI), according to a meta-analysis in the British Medical Journal.

A systematic review of the literature identified seven controlled trials, six of them randomized, of antimicrobial treatment to prevent symptomatic UTI after removal of a short-term urinary catheter (14 days or less). The meta-analysis included data on 665 patients taking various antimicrobial drugs, for various durations, and 855 taking control treatments. Most of the studies included postoperative patients.

On pooled data analysis, there was a 5.8 percent absolute reduction in UTI risk in patients taking antimicrobial prophylaxis. The risk ratio for UTI in the antimicrobial group was 0.45. Seventeen patients had to be treated with antimicrobial prophylaxis to prevent one UTI.

Even with prompt catheter removal, hospitalized patients with urinary catheterization are at risk of UTI. Despite previous randomized trials, the benefits of antimicrobial prophylaxis in reducing this risk are unclear.

The new meta-analysis suggests a reduction of more than one-half of the risk of UTI for patients receiving antimicrobial prophylaxis after short-term catheterization. Further studies are needed to identify the patient subgroups most likely to benefit from antimicrobial prophylaxis, with attention to minimizing side effects, costs, and antimicrobial resistance [Marschall J, et al. Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis. BMJ 2013; 346:f3263].